title: Mortality and psychiatric disorders among public mental health care clients in Utrecht: a register-based cohort study.
abstract: BACKGROUND
  Different studies have shown similar or even lower mortality among homeless persons with compared to homeless persons without a severe mental disorder.
  
  
  OBJECTIVE
  To clarify the association between presence of a psychiatric diagnosis and mortality among the socially marginalized.
  
  
  METHODS
  The Public Mental health care (PMHc) is a legal task of the municipal authority aiming at prevention and intervention in case of (imminent) homelessness among persons with a serious shortage of self-sufficiency. The data of PMHc clients (N=6,724) and personally matched controls (N=66,247) were linked to the registries of Statistics Netherlands and analysed in a Cox model.
  
  
  RESULTS
  The increased mortality among PMHc clients, compared to the general population (HR=2.99, 95%-CI: 2.63-3.41), was associated with a broad range of death causes. Clients with a record linkage to the Psychiatric Case Registry Middle Netherlands ('PMHc+') had an increased risk of suicide (HR=2.63, 0.99-7.02, P=0.052), but a lower risk of natural death causes (HR=0.71, 0.54-0.92, P=0.011), compared to clients without this record linkage ('PMHc-'). Compared to controls, however, 'PMHc-' clients experienced substantially increased risks of suicide (HR=3.63, 1.42-9.26, P=0.007) and death associated with mental and behavioural disorders (ICD-10 Ch.V) (HR=7.85, 3.54-17.43, P<0.001).
  
  
  CONCLUSIONS
  Psychiatric services may deliver an important contribution to the prevention of premature natural death among the socially marginalized.
  The earlier observed lower mortality among vulnerably housed and homeless persons with a psychiatric diagnosis compared to vulnerably housed and homeless persons without a psychiatric diagnosis appears to be due to a significantly lower risk of natural causes of death. Compared to controls from the general population, vulnerably housed and homeless persons without registered diagnosis at a local psychiatric service have a significantly increased mortality associated both with natural death causes and with suicide and death due to mental and behavioural disorders. Services for mental health care may deliver an important contribution to the prevention of premature death due to somatic disorders among the socially marginalized.
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands f.termorshuizen@umcutrecht.nl.
authors.forename: Fabian
authors.initials: F
authors.lastname: Termorshuizen
authors.affiliation: Department of Health Promotion and Epidemiology, Municipal Health Service Utrecht, Utrecht, The Netherlands.
authors.forename: Addi P L
authors.initials: AP
authors.lastname: van Bergen
authors.affiliation: Department of Social Health Care, Municipal Health Service Utrecht, Utrecht, The Netherlands.
authors.forename: Ronald B J
authors.initials: RB
authors.lastname: Smit
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Hugo M
authors.initials: HM
authors.lastname: Smeets
authors.affiliation: Department of Health Promotion and Epidemiology, Municipal Health Service Utrecht, Utrecht, The Netherlands.
authors.forename: Erik J C
authors.initials: EJ
authors.lastname: van Ameijden
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Mortality; homelessness; psychiatric case registry; psychiatry